右美托咪定复合硬膜外阻滞对老年妇科腹腔镜手术患者血流动力学、炎症反应和认知功能的影响

Effects of dexmedetomidine combined with epidural block on hemodynamics,inflammatory response and cognitive function in elderly patients undergoing laparoscopic gynecological surgery

目的:分析右美托咪定复合硬膜外阻滞对老年妇科腹腔镜手术患者血流动力学、炎症反应和认知功能的影响。方法:选取88例行妇科腹腔镜手术的老年患者作为研究对象,依据麻醉方式不同分为对照组和观察组,每组各44例。对照组予以硬膜外阻滞复合全身麻醉;观察组在此基础上予以右美托咪定。比较两组手术时间、苏醒时间、术中出血量、不同时间段收缩压(SBP)、舒张压(DBP)、心率(HR)、白细胞介素6(IL-6)、去甲肾上腺素(NE)、简易智力状况检查量表(MMSE)、视觉模拟评分(VAS)及Ramsay镇静评分。结果:两组患者手术时间、苏醒时间、术中出血量比较,差异均无统计学意义(P>0.05);T_(1)~T_(4)时刻,两组HR均降低(P<0.05),且观察组低于对照组(P<0.05);T_(2)~T_(4)时刻,观察组SBP、DBP均低于对照组(P<0.05);术后24 h及72 h,观察组IL-6、NE水平均低于对照组(P<0.05);术后6、24、72 h,两组MMSE评分均降低(P<0.05),但观察组高于对照组(P<0.05);术后6、12、24 h,观察组VAS评分低于对照组(P<0.05),Ramsay评分高于对照组(P<0.05);观察组不良反应发生率为9.09%,低于对照组的27.27%(P<0.05)。结论:右美托咪定复合硬膜外阻滞对患者血压、心率控制较好,对患者炎症因子水平影响较小,能够有效改善患者术后认知功能障碍。

Objective:To analyze the effects of dexmedetomidine combined with epidural block on hemodynamics,inflammatory response and cognitive function in elderly patients undergoing laparoscopic gynecological surgery.Methods:88 elderly patients who underwent gynecological laparoscopic surgery were selected as the research objects,and they were divided into control group and observation group according to different anesthesia methods,with 44 cases in each group.The control group was given epidural block combined with general anesthesia,and the observation group was given dexmedetomidine on the basis of this.The operation time,recovery time and intraoperative blood loss,systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),interleukin-6(IL-6),noadrenaline(NE),Simple Mental State Examination Scale(MMSE),visual simulation Scale(VAS)and Ramsay sedation score at different time periods were compared between the two groups.Results:There were no significant differences in operation time,recovery time and intraoperative blood loss between the two groups(P>0.05).From T_(1) to T_(4),HR of both groups was decreased compared with that of T0(P<0.05),and observation group was lower than control group(P<0.05).At T_(2)~T_(4),SBP and DBP of observation group were lower than those of control group(P<0.05).The levels of IL-6 and NE in observation group were lower than those in control group at 24 and 72 h after surgery(P<0.05).At 6,24 and 72 h after surgery,MMSE scores of both groups were decreased(P<0.05),the observation group was higher than the control group(P<0.05).The VAS score of the observation group was lower than that of the control group(P<0.05),and the Ramsay score of the observation group was higher than that of the control group at 6,12 and 24 h after surgery(P<0.05).The incidence of adverse reactions in observation group(9.09%)was lower than 27.27%in control group(P<0.05).Conclusion:Dexmedetomidine combined with epidural block can better control the blood pressure and heart rate of patients,and has little influence on the level of inflammatory factors in patients,which can effectively improve the postoperative cognitive dysfunction of patients.